Get Flexible Spending Account Claim Form 2011

Filling out the Flexible Spending Account (FSA) Claim Form 2011 online is a straightforward process that can help you efficiently request reimbursement for eligible medical expenses. This guide will provide step-by-step instructions to ensure you complete the form accurately and comprehensively.

Follow the steps to effectively complete your claim form online.

1. Press the ‘Get Form’ button to download the FSA Claim Form 2011 and open it in your preferred document editor.
2. Indicate the appropriate account by selecting either the Flexible Spending Health Account (FSA) or the Health Reimbursement Account (HRA) option.
3. Provide your employer's name and your personal details including your last name, first name, social security number, address, city, state, email, phone number, and zip code.
4. Check the box if you have a new address to ensure accurate processing.
5. If applicable, check the box for ‘Debit Card (MySource)’ to indicate if you are using a debit card for this claim.
6. List all eligible expenses for reimbursement in the provided sections, including the date the service was provided, the type of service, and the name of the person who received the service.
7. Attach approved documentation as specified; include receipts that detail the date, service performed, and eligibility, ensuring that each service documented corresponds to the claimed expenses.
8. Complete the certification statement by reading and ensuring your understanding of the reimbursements, providing your signature and the date signed.
9. Once all fields are completed and reviewed for accuracy, you can save the form, download it for your records, print it, or share it as required.

Start filling out your Flexible Spending Account Claim Form online today to ensure you receive your reimbursement promptly.